Aldosterone Resistance in Preterm Infants

NCT ID: NCT01176162

Last Updated: 2014-04-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

170 participants

Study Classification

OBSERVATIONAL

Study Start Date

2010-01-31

Study Completion Date

2013-12-31

Brief Summary

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In the neonatal period, the human kidney is characterized by a functional immaturity responsible for an impaired ability to regulate water and sodium homeostasis, which is exacerbated by prematurity. This altered sodium handling could be related to a partial renal aldosterone resistance. Renal sodium reabsorption and potassium excretion are mainly controlled by aldosterone, after binding to the mineralocorticoid receptor (MR). The investigators have analyzed MR expression throughout human and mouse renal development, and the investigators found a weak MR expression at birth. The investigators have conducted a pilot study in full-term newborns, which confirmed a partial neonatal aldosterone resistance. This study also highlighted that urinary aldosterone is the best index to accurately assess aldosterone sensitivity at birth.

Detailed Description

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Principal objective:

To assess aldosterone resistance at birth by a non invasive measurement of urinary aldosterone, in order to evaluate its intensity as a function of gestational age. Determination of normal values of urinary aldosterone concentration in each group.

Secondary objectives:

Comparison of plasma and urinary electrolytes concentrations with hormonal measurements and clinical parameters. Evolution of these biological parameters throughout the first year of life, depending on gestational age at birth.

Methodology : multicentric study, open study Two hundred-forty newborns will be included in order to constitute 4 groups of 60 children, classified according to their gestational age: \< 28 GW, 28 - \< 33 GW, 33- \< 37 GW, \> 37 GW.

Inclusion criteria: every newborn will be included, after written parental consent was obtained.

Study :

Urinary samples will be collected onto a gauze compress, during the first 24 hours of life, at day three, and at 1, 3, 6 and 12 months. A blood sample will be obtained from systematic umbilical cord blood collection at birth and during the Guthrie test at day three. Aldosterone and renin concentrations will be measured in BICETRE Hospital laboratory. Plasma and urinary electrolyte concentrations will be measured in the Biochemistry department. DNA samples will also be gathered from umbilical cord blood for future genetic investigations (functional polymorphisms of the MR gene).

Perspectives This study will permit to assess the intensity of aldosterone resistance in full-term and preterm newborns, by a non invasive method. It should bring new insights into the mechanisms of hormonal regulation of sodium balance in preterm newborns and during the first year of life. Urinary aldosterone assessments may open new perspectives for therapeutic management of water and sodium waste in premature infants.

Conditions

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Newborn

Keywords

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Non Invasive measurement Preterm infants Aldosterone resistance

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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Group "< 28"

• Gestational Age \< 28 weeks

No interventions assigned to this group

Group "28 - < 33"

• Gestational Age : 28 - \< 33 weeks

No interventions assigned to this group

Group "33- < 37"

Gestational Age : 33- \< 37 weeks

No interventions assigned to this group

Group "> 37"

Gestational Age \> 37 weeks

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Maternal

* Maternal age ≥ 18 and ≤ 45 years,
* Written parental consent
* Normal obstetrical ultrasounds
* Neonatal - Birth by vaginal delivery or cesarean section

Exclusion Criteria

* Maternal

* Type 1 or type 2 diabetes,
* Adrenal or hypophyseal deficiency
* Treatment for arterial hypertension
* Neonatal

* Perinatal anoxia (defined by an Apgar score \< 5 at 5 min and pH \< 7,10 and lactacidemia \> 9 mmol/l at blood cord).
* Congenital malformation
* Chromosomic abnormalities
Minimum Eligible Age

24 Weeks

Maximum Eligible Age

41 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Institut National de la Santé Et de la Recherche Médicale, France

OTHER_GOV

Sponsor Role collaborator

Assistance Publique - Hôpitaux de Paris

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Pascal BOILEAU, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Assistance Publique - Hôpitaux de Paris

Locations

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Assistance Publique- Hôpitaux de Paris: Antoine Beclere Hospital

Clamart, Île-de-France Region, France

Site Status

Countries

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France

References

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Martinerie L, Viengchareun S, Delezoide AL, Jaubert F, Sinico M, Prevot S, Boileau P, Meduri G, Lombes M. Low renal mineralocorticoid receptor expression at birth contributes to partial aldosterone resistance in neonates. Endocrinology. 2009 Sep;150(9):4414-24. doi: 10.1210/en.2008-1498. Epub 2009 May 28.

Reference Type BACKGROUND
PMID: 19477942 (View on PubMed)

Martinerie L, Pussard E, Yousef N, Cosson C, Lema I, Husseini K, Mur S, Lombes M, Boileau P. Aldosterone-Signaling Defect Exacerbates Sodium Wasting in Very Preterm Neonates: The Premaldo Study. J Clin Endocrinol Metab. 2015 Nov;100(11):4074-81. doi: 10.1210/jc.2015-2272. Epub 2015 Sep 8.

Reference Type DERIVED
PMID: 26348350 (View on PubMed)

Other Identifiers

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B91017-20

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

P081211

Identifier Type: -

Identifier Source: org_study_id